Background Gemtuzumab ozogamicin (GO) is a humanised anti-CD33 monoclonal antibody conjugated with calicheamicin. Several studies show its safety and efficacy in refractory/relapsed acute myeloid leukaemia (AML). Nevertheless in July 2010 it was withdrawn from the US market after a study failed to confirm the clinical benefits of GO.
Purpose Following this controversy, we conducted a retrospective study to evaluate its efficacy and safety in children with refractory/relapsed AML.
Materials and Methods The study focused on the 19 children treated after approval by the French drug safety agency, between October 2006 and June 2012.
Results The median age at initial diagnosis was 6.7 years (0.5–15.3). Three patients were refractory to first-line treatment, one patient was in refractory first relapse, three were in first relapse after stem cell transplantation (SCT), three in second relapse after SCT, one in third relapse after SCT, seven were in first relapse and one in second relapse. Patients received: one dose of 3 mg/m² with cytarabine (day 1 to 7); or 9 mg/m² fractionated dose (on days 1, 4, 7) in monotherapy or associated with cytarabine (day 1 to 7); or 4.5 mg/m² on day 6 associated with fludarabine and daunorubicin liposomal. Nine complete remissions were obtained (48%) in 32 days, leading to further curative treatment. The one year overall survival was 26% (5 patients). For the others complete remission was maintained for 6–9 months before relapse or death. Grade 3–4 haematological adverse events were identified in all children including severe thrombocytopenia requiring transfusion. Sepsis (n = 2), fever (n = 3), vomiting (n = 6) were documented. One case of sinusoidal obstruction syndrome was reported.
Conclusions Children with refractory/relapsed AML have a dismal outcome and there is a lack of effective treatments. In our cohort GO led to nearly 50% of CRs and even if the long term survival is still unsatisfactory it should remain available in this indication.
No conflict of interest.
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